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Get Ballad Health Application For Financial Assistance 2020-2024

, Please provide all documentation listed below that applies. Sign and return to the address listed below. Documentation should include all family members in the household. Required Documentation (*Do not send originals * Please use black ink) Last two years of Federal Tax Returns are required. If you did not file taxes, you must provide a 4506-T form from the IRS. W-2 and last 3 pay stubs. If you are drawing Social Security, Disability, or a Military Pension, you will need to pro.

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